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A standardized linear-stapled side-to-side anastomotic technique in robot-assisted Ivor Lewis esophagectomy : a retrospective analysis of 350 consecutive cases from a prospective registry

Zeyara, A LU orcid ; Kouwenhoven, E A ; Mantel, H T J and van Det, M J (2026) In Journal of Robotic Surgery 20(1).
Abstract

Early experiences with robotic-assisted esophagectomy showed disappointing anastomotic outcomes when techniques were directly translated from open or thoracoscopic surgery. Among intrathoracic anastomotic options in robot-assisted Ivor Lewis esophagectomy (RAMIE-IL), emerging data suggest lower complication rates with the linear stapled side-to-side technique. This method was adopted at our institution in 2018. Here, we present our outcomes and describe our standardized linear-stapled side-to-side anastomosis for RAMIE-IL. The primary objective of this study was to detail the surgical technique and evaluate postoperative outcomes of a linear-stapled side-to-side anastomosis in RAMIE-IL. This retrospective cohort study used prospectively... (More)

Early experiences with robotic-assisted esophagectomy showed disappointing anastomotic outcomes when techniques were directly translated from open or thoracoscopic surgery. Among intrathoracic anastomotic options in robot-assisted Ivor Lewis esophagectomy (RAMIE-IL), emerging data suggest lower complication rates with the linear stapled side-to-side technique. This method was adopted at our institution in 2018. Here, we present our outcomes and describe our standardized linear-stapled side-to-side anastomosis for RAMIE-IL. The primary objective of this study was to detail the surgical technique and evaluate postoperative outcomes of a linear-stapled side-to-side anastomosis in RAMIE-IL. This retrospective cohort study used prospectively collected registry data of all consecutive patients undergoing RAMIE-IL with an intrathoracic linear-stapled side-to-side anastomosis at ZGT Almelo, The Netherlands. All patients from inception (July 1st, 2018) until November 15th, 2025, were included. Data were obtained from the Dutch Upper GI Cancer Audit (DUCA) registry. 350 consecutive patients were included. Mean age was 66 years, 70% were male and 44% had an ASA-class of 3 or more. Length of ICU stay was median 1 days. Length of hospital stay was median 7 days. Overall anastomotic leak rate was 4%. Overall rate of all Clavien-Dindo ≥ 3 complications was 14%. Readmission rate within 30 days was 12.5%. 30-day mortality rate was 1.7%. The presented linear-stapled side-to-side anastomotic technique is feasible and associated with a low rate of anastomotic complications in the studied cohort.

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author
; ; and
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Humans, Esophagectomy/methods, Anastomosis, Surgical/methods, Retrospective Studies, Registries, Robotic Surgical Procedures/methods, Male, Female, Aged, Surgical Stapling/methods, Length of Stay, Middle Aged, Postoperative Complications/epidemiology, Treatment Outcome, Prospective Studies, Esophageal Neoplasms/surgery
in
Journal of Robotic Surgery
volume
20
issue
1
article number
204
publisher
Springer Nature
external identifiers
  • pmid:41577871
  • scopus:105028385846
ISSN
1863-2483
DOI
10.1007/s11701-025-03132-4
language
English
LU publication?
no
additional info
© 2026. The Author(s).
id
eca3edb1-f5d5-47db-947a-256d249409e8
date added to LUP
2026-08-20 15:09:34
date last changed
2026-09-18 05:44:25
@article{eca3edb1-f5d5-47db-947a-256d249409e8,
  abstract     = {{<p>Early experiences with robotic-assisted esophagectomy showed disappointing anastomotic outcomes when techniques were directly translated from open or thoracoscopic surgery. Among intrathoracic anastomotic options in robot-assisted Ivor Lewis esophagectomy (RAMIE-IL), emerging data suggest lower complication rates with the linear stapled side-to-side technique. This method was adopted at our institution in 2018. Here, we present our outcomes and describe our standardized linear-stapled side-to-side anastomosis for RAMIE-IL. The primary objective of this study was to detail the surgical technique and evaluate postoperative outcomes of a linear-stapled side-to-side anastomosis in RAMIE-IL. This retrospective cohort study used prospectively collected registry data of all consecutive patients undergoing RAMIE-IL with an intrathoracic linear-stapled side-to-side anastomosis at ZGT Almelo, The Netherlands. All patients from inception (July 1st, 2018) until November 15th, 2025, were included. Data were obtained from the Dutch Upper GI Cancer Audit (DUCA) registry. 350 consecutive patients were included. Mean age was 66 years, 70% were male and 44% had an ASA-class of 3 or more. Length of ICU stay was median 1 days. Length of hospital stay was median 7 days. Overall anastomotic leak rate was 4%. Overall rate of all Clavien-Dindo ≥ 3 complications was 14%. Readmission rate within 30 days was 12.5%. 30-day mortality rate was 1.7%. The presented linear-stapled side-to-side anastomotic technique is feasible and associated with a low rate of anastomotic complications in the studied cohort.</p>}},
  author       = {{Zeyara, A and Kouwenhoven, E A and Mantel, H T J and van Det, M J}},
  issn         = {{1863-2483}},
  keywords     = {{Humans; Esophagectomy/methods; Anastomosis, Surgical/methods; Retrospective Studies; Registries; Robotic Surgical Procedures/methods; Male; Female; Aged; Surgical Stapling/methods; Length of Stay; Middle Aged; Postoperative Complications/epidemiology; Treatment Outcome; Prospective Studies; Esophageal Neoplasms/surgery}},
  language     = {{eng}},
  month        = {{01}},
  number       = {{1}},
  publisher    = {{Springer Nature}},
  series       = {{Journal of Robotic Surgery}},
  title        = {{A standardized linear-stapled side-to-side anastomotic technique in robot-assisted Ivor Lewis esophagectomy : a retrospective analysis of 350 consecutive cases from a prospective registry}},
  url          = {{http://dx.doi.org/10.1007/s11701-025-03132-4}},
  doi          = {{10.1007/s11701-025-03132-4}},
  volume       = {{20}},
  year         = {{2026}},
}